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Background: In healthcare important phenomena of perceived incompatibility between professional and managerial values have emerged as consequences of NPM reforms. Although there is a growing evidence on the variation in the enactment of hybrid roles by medical managers, existing research in healthcare management is mostly descriptive with little emphasis on the conditions under which hybrid roles are enacted and, importantly, on the effects of this variation on performance. Purpose: In this paper we seek to fill this research gap by empirically examining (i) whether budgetary participation aligns professional and organizational values; (ii) the impact of this alignment on employees’ work-related feelings and managerial performance; and (iii) the effect of professional identity on value congruence. Methodology: Data were collected by a survey conducted in an Italian Hospital and PLS was used to test the relationships among variables. Results: Overall, results show that: (i) high involvement in budgeting is instrumental in facilitating medical managers’ value congruence and this, in turn positively effects managerial job engagement; (ii) the effect of budgetary participation on value congruence depends on the extent of professional identity; (iii) as a result of enhanced value congruence and managerial job engagement, employees tend to deliver superior role performance. Practice implication: Findings of this study provide some guidance for managers in how organizations can take steps to guarantee effective support to hybrid professionals.